AB1536-HPR DEVELOPING WORK-ON - VOCATIONAL REHABILITATION FOR PATIENTS WITH INFLAMMATORY ARTHRITIS
Authors: C. M. T. Madsen, J. Primdahl, A. Bremander, L. Eggen, J. Reffstrup Christensen
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with inflammatory arthritis (IA), i.e. rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis, experience low work ability, an increased risk of long-term sickness absence and up to 38% lose their job in the first years after diagnosis. This affects the patients’ identity and has economic consequences for the individual as well as for the society. Patients with IA need vocational rehabilitation (VR) to increase their work ability, decrease their sickness absence, and risk of losing their job. Positive results from VR for patients with IA are limited (1). Objectives To describe the development of a VR, WORK-ON. Methods The development process was based on the Medical Research Council’s framework for Complex Interventions and ran in two phases (2). Phase 1, the evidence base: identifying existing evidence through a scoping review and theories (occupational balance, self-management and shared decision making) considered useful for VR. In addition, interviews with 15 patients with IA and 21 health professionals were performed and analysed (3). Phase 2, program development: a workshop was held with patient research partners, researchers, health professionals from a hospital specialised in rheumatological rehabilitation, and from a municipal job center. By repetitive feedback from the stakeholders, the WORK-ON was modelled, remodeled, and described in a manual. Patient research partners were involved throughout the process. Results The duration of WORK-ON will be eight months and includes 6 - 11 meetings (30-60 minutes) depending on the patients’ needs. The WORK-ON intervention consists of four parts: 1) Initial assessment and goalsetting by an occupational therapist, 2) Coordination by an occupational therapist throughout the VR and assistance in navigation across primary and secondary health and social care including follow up.The coordinator is responsible for individual support concerning issues such as energy management, coping with the disease and concerns related to work. 3) Group sessions together with other patients with IA for peer support, and 4) Individually tailored VR consultations with physiotherapists, nurses, or social workers. Multidisciplinary team discussions will be held with the patient, relatives and all involved partners from the patients’ municipality and the hospital to evaluate the VR and decide the next step after eight months. Suggested primary outcome measures are the Occupational Balance Questionnaire (OBQ) and the Work Productivity and Activity Impairment questionnaire (WPAI). Secondary outcomes are health related quality of life (EQ-5D-5L), number of days of sickness absence over a year, VAS pain, fatigue, and global assessment. Conclusion WORK-ON was developed with input from various stakeholders and is ready to be tested in a feasibility study after training of the health professionals, who will deliver the VR. Depending on feasibility and indications of efficacy, the primary outcome will be selected and the effect of WORK-ON will be tested in a subsequent RCT study on IA patients in Denmark or further developed in a second feasibility study. Furthermore, a realistic evaluation will be conducted by interviews with patients and health professionals to determine the quality of implementation, contextual factors, and mechanisms. References [1]Madsen CMT, Bisgaard SK, Primdahl J, Christensen JR, von Bülow C. A Systematic Review of Job Loss Prevention Interventions for Persons with Inflammatory Arthritis. J Occup Rehabil. 2021;31(4):866-85. [2]Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. 2021;374:n2061. [3]Madsen CMT, Christensen JR, Bremander A, Primdahl J. Perceived challenges at work and need for professional support among people with inflammatory arthritis - a qualitative interview study. Scand J Occup Ther. 2021:1-10. Figure 1. Illustration of WORK-ON Disclosure of Interests None declared